A recent health survey throws up figures that defy logic. Some districts in India’s nine most backward states have curbed infant mortality rates to much lower than the national average. Down To Earth travels to some of these districts to understand how they have succeeded in breaking the mould. Vibha Varshney, Sonal Matharu, Ankur Paliwal and Dinsa Sachan report
At least 103 babies die for every 1,000 live births in Shravasti, a district in Uttar Pradesh that borders Nepal, reports the Annual Health Survey 2010-11. Though this first-of-its-kind district-wise survey is limited to nine most backward states, the number is the worst in the country. Infant mortality rate (IMR) is less than six in the European Union. By India’s own estimates, Kerala has the lowest IMR of 14. Yet Shravasti’s plight does not raise eyebrows as it comes at a time when Uttar Pradesh is entangled in allegations of siphoning Rs 5,000 crore off the National Rural Health Mission (NRHM). The mission has programmes to reduce child and maternal mortality by improving healthcare delivery in rural areas. What comes as a surprise is despite such crumbling health and administrative systems, Hamirpur, another district in the state, has managed to keep its IMR much lower than the national rural average of 51 (see table).
Annual Health Survey is done by the Office of Registrar General of India, which carries out state-wise Sample Registration Survey every year.
In fact, all the states covered in the survey have certain areas that buck the trend. Most states have at least one district with IMR much lower than the national average; some have already attained the UN’s Millenium Development Goals of 28 by 2015. Some states also have districts whose IMR is comparable to that of war-torn countries.At an IMR of 103, Odisha’s Balangir district is worse than that of the world’s poorest countries like Mali and Burundi. This is puzzling.
As Down To Earth travels to districts with worst rural IMRs, it realises these areas could not have fared any better. Doctors and nurses are unwilling to serve these areas. Shravasti, for instance, has only one paediatrician to cater to the population of over a million. Even districts with best rural IMR reel from short supply of iron and folic acid, which are a must for pregnant women.
What seems to be working in these areas are ASHAs (Accredited Social Health Activists), appointed under NRHM, and rural health workers like ANMs (auxiliary nurse midwives) appointed by the district administration. In Bilaspur, a course for rural medical assistants is paying off. And in Rudraprayag, where the tough terrain creates a barrier between the healthcare system and people, dais or traditional midwives are the saviours.